Provider Demographics
NPI:1720674971
Name:ROSERO-FRICKE, NHORA EDITH
Entity Type:Individual
Prefix:
First Name:NHORA
Middle Name:EDITH
Last Name:ROSERO-FRICKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 BISCAYNE PL
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20164-1106
Mailing Address - Country:US
Mailing Address - Phone:540-336-0866
Mailing Address - Fax:571-350-8507
Practice Address - Street 1:46179 WESTLAKE DR STE 340
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-5874
Practice Address - Country:US
Practice Address - Phone:571-350-8507
Practice Address - Fax:571-350-8507
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-11
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704010617101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health